Last update Dec. 25, 2021

Azithromycin

Compatible

Safe product and/or breastfeeding is the best option.

Macrolide with actions and uses similar to those of erythromycin. Oral administration once a day.

Excreted in very low levels into breast milk (Sutton 2015, Salman 2015, Kelsey 1994) and no problems have been observed in infants whose mothers have taken it. (Goldstein 2009)

Commonly used for pediatric treatment.

Expert authors consider Azithromycin compatible with breastfeeding. (Butler 2014, Kong 2013, Khrianin 2010, Chen 2010, Goldstein 2009, Mahadevan 2006, Bar-Oz 2003, Chin 2001)

Early exposition (first 15 days of life) to Macrolides (mostly Erythromycin) have been related to hypertrophic pyloric stenosis (Lund 2014, Maheshwai 2007, Sørensen 2003), but not others, including two meta-analysis (Almaramhy 2019, Abdellatif 2019). This association has not been observed with Azithromycin. (Goldstein 2009, Maheshwai 2007).

Although rare, the possibility of transient gastroenteritis due to alteration of the intestinal flora in infants whose mothers take antibiotics should be taken into account. (Benyamini 2005)


See below the information of this related product:

  • Erythromycin (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

Alternatives

We do not have alternatives for Azithromycin since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Other names

Azithromycin in other languages or writings:

Groups

Azithromycin belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Azithromycin in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 40 %
Molecular weight 785 daltons
Protein Binding 7 - 51 %
Tmax 2 - 4 hours
T½ 48 - 68 hours
Theoretical Dose 0.4 mg/Kg/d
Relative Dose 5 %
Ped.Relat.Dose 4 %

References

  1. Abdellatif M, Ghozy S, Kamel MG, Elawady SS, Ghorab MME, Attia AW, Le Huyen TT, Duy DTV, Hirayama K, Huy NT. Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr. 2019 Mar;178(3):301-314. Abstract
  2. van Wattum JJ, Leferink TM, Wilffert B, Ter Horst PGJ. Antibiotics and lactation: An overview of relative infant doses and a systematic assessment of clinical studies. Basic Clin Pharmacol Toxicol. 2019 Jan;124(1):5-17. Abstract
  3. Almaramhy HH, Al-Zalabani AH. The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Ital J Pediatr. 2019 Feb 4;45(1):20. Abstract
  4. Sutton AL, Acosta EP, Larson KB, Kerstner-Wood CD, Tita AT, Biggio JR. Perinatal pharmacokinetics of azithromycin for cesarean prophylaxis. Am J Obstet Gynecol. 2015 Jun;212(6):812.e1-6. Abstract Full text (link to original source) Full text (in our servers)
  5. Salman S, Davis TM, Page-Sharp M, Camara B, Oluwalana C, Bojang A, D'Alessandro U, Roca A. Pharmacokinetics of Transfer of Azithromycin into the Breast Milk of African Mothers. Antimicrob Agents Chemother. 2015 Dec 28;60(3):1592-9. Abstract
  6. Lund M, Pasternak B, Davidsen RB, Feenstra B, Krogh C, Diaz LJ, Wohlfahrt J, Melbye M. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 2014 Mar 11;348:g1908. Abstract Full text (link to original source) Full text (in our servers)
  7. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014 Mar;70(3):417.e1-10; quiz 427. Abstract
  8. Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013 Jun;73(8):779-87. Abstract
  9. Chen LH, Zeind C, Mackell S, LaPointe T, Mutsch M, Wilson ME. Breastfeeding travelers: precautions and recommendations. J Travel Med. 2010 Jan-Feb;17(1):32-47. Abstract Full text (link to original source) Full text (in our servers)
  10. Khrianin AA, Reshetnikov OV. [Use of macrolides in pregnancy and lactation according to evidence-based medicine: pro et contra]. Antibiot Khimioter. 2010 Abstract
  11. Goldstein LH, Berlin M, Tsur L, Bortnik O, Binyamini L, Berkovitch M. The safety of macrolides during lactation. Breastfeed Med. 2009 Dec;4(4):197-200. Abstract
  12. Maheshwai N. Are young infants treated with erythromycin at risk for developing hypertrophic pyloric stenosis? Arch Dis Child. 2007 Abstract Full text (link to original source) Full text (in our servers)
  13. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  14. Benyamini L, Merlob P, Stahl B, Braunstein R, Bortnik O, Bulkowstein M, Zimmerman D, Berkovitch M. The safety of amoxicillin/clavulanic acid and cefuroxime during lactation. Ther Drug Monit. 2005 Abstract
  15. Sørensen HT, Skriver MV, Pedersen L, Larsen H, Ebbesen F, Schønheyder HC. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 2003;35(2):104-6. Abstract
  16. Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D, Bortnik O, Berkovitch M. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003 Abstract
  17. Chin KG, McPherson CE 3rd, Hoffman M, Kuchta A, Mactal-Haaf C. Use of anti-infective agents during lactation: Part 2--Aminoglycosides, macrolides, quinolones, sulfonamides, trimethoprim, tetracyclines, chloramphenicol, clindamycin, and metronidazole. J Hum Lact. 2001 Feb;17(1):54-65. Abstract
  18. Kelsey JJ, Moser LR, Jennings JC, Munger MA. Presence of azithromycin breast milk concentrations: a case report. Am J Obstet Gynecol. 1994 Abstract
  19. Periti P, Mazzei T, Mini E, Novelli A. Clinical pharmacokinetic properties of the macrolide antibiotics. Effects of age and various pathophysiological states (Part I). Clin Pharmacokinet. 1989 Abstract

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